Acorn House Care Centre

Acorn House Care Centre is a residential care home which provides personal care for up to 32 older people and people living with dementia. Accommodation is provided over two floors and a passenger lift is available to provide access to both floors. At the time of the inspection 30 people were living at the home.

People’s experience of using this service and what we found

People told us they felt safe living at the home. We received mixed feedback about staffing levels and have made a recommendation about this. Staff followed safe infection control practices, including wearing appropriate personal protective equipment (PPE) to protect people from COVID-19 and the risk of cross infection. The provider ensured staff were recruited safely and were suitable to support people living at the home. People were protected from the risk of abuse or avoidable harm and appropriate action was taken to manage accidents and incidents. Staff managed people’s medicines safely, in line with national guidance. The safety of the home environment was checked regularly.

Staff knew the people they supported and provided them with individualised care that reflected their needs, risks and preferences. They encouraged people to make choices when they could. People’s care documentation included detailed information to guide staff about how to support people well and was reviewed and updated regularly. People’s end of life care wishes had been discussed with them, or their relatives where appropriate. People were happy with the range of activities available at the home. The provider managed concerns and complaints appropriately.

The manager and staff were clear about their responsibilities. They focused on providing people with high quality care, which reflected their needs and preferences. The service worked in partnership with a variety of community professionals to ensure people received any specialist support they needed. Management sought people’s views about the service and acted upon them. Everyone we spoke with was happy with the management of the service. The regular checks and audits completed by management were effective in ensuring appropriate standards of quality and safety were maintained at the home.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for the service was requires improvement (published 15 January 2021).

For those key questions not inspected, we used the ratings awarded at the last inspection where those key question were reviewed, to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good, based on the findings of this inspection

Why we inspected

This was a planned inspection to follow up on the breach of regulation that had been identified at the inspection in September 2019 but had not been reviewed during the inspection in December 2020.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Acorn House Care Home is a residential care home providing accommodation, care for up to 32 people aged 65 and over, some of who were living with dementia. At the time of the inspection, there were 31 people living in the home.

Acorn House Care Centre is a purpose-built home over two floors. People had access to a number of communal areas, including quiet spaces and a garden.

People’s experience of using this service and what we found

Systems and processes safeguarded people from the risk of abuse. People told us they felt safe and staff were confident the management team would act quickly to keep people safe. Effective systems were in place to ensure lessons were learnt from any incidents and the management team understood their responsibility to be open and honest when something went wrong.

Environmental risks and risks to people's health, safety and wellbeing were managed well and kept under review. Equipment was safe to use and regularly serviced and maintained. Recruitment processes had improved and ensured staff were suitable to work with vulnerable people. There were mixed views about staffing, particularly in the evening. The registered manager had recently changed ways of working and this was currently under review.

The home was clean and odour free and staff followed safe infection control practices. Additional systems and guidance were in place to reduce the risk of infection during the pandemic. Medicines were managed safely. People and their relatives told us staff were kind and caring and were complimentary about the improvements made. The service had equality and diversity policies and procedures in place. People’s privacy and dignity were respected.

People were supported to live healthy lives and had access to professionals, a well-trained staff team and a choice of a nutritious diet. The home worked with partnership with other organisations to provide effective and consistent care. Staff received the training and support needed to carry out their role. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The management team and staff had worked hard to address the shortfalls found at the last inspection and were clear about further improvements needed. There were effective systems to check the quality of the service and to monitor staff practice with clear evidence improvements had taken place. People's views were sought about the service and acted on. Where possible, people were involved in decisions about their care and support; care was being planned in a person-centred way and regularly reviewed which helped ensure good outcomes for people. Records were accurate and organised. The service engaged with external professionals to ensure people received prompt and coordinated care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 03 October 2019). There were breaches of regulation in relation to recruitment processes, supervision and support for staff, medicines management, care planning, record keeping and ineffective monitoring systems. We also made recommendations about capacity assessments, dementia friendly environments and involving people in decisions about their care. After the last inspection, the provider completed an action plan to show what they would do and by when, to improve.

During this inspection, the provider demonstrated that improvements have been made in Safe, Effective, Caring and Well-Led. However, the rating is limited to requires improvement as there is a breach of regulation in one of the other key questions. The service remains rated requires improvement.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 3 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Caring and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains at Requires Improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Acorn House Care Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Acorn House Care Centre is a residential care home providing personal and nursing care to 30 people aged 65 and over at the time of the inspection. The service can support up to 32 people in one purpose-built building. Bedrooms comprised of 32 single bedrooms, all of which had en-suite facilities, spread over two floors. People had access to a number of communal areas, including quiet spaces and a garden.

People’s experience of using this service and what we found

The provider failed to ensure robust recruitment processes were consistently in place when recruiting new staff. Staff had not received regular supervisions and appraisals to support them in their roles. Medicines were not always managed safely, and we observed poor practice during our inspection. The registered manager failed to ensure care plans were person-centred, regularly reviewed and updated when needs changed. Staff also told us they did not read care plans, although were able to tell us how they supported people. The registered manager failed to ensure records were accurate and updated. The provider and registered manager failed to ensure audits were sufficiently robust to drive improvements and some audits were not being completed.

We have made recommendations about capacity assessments, dementia friendly environments and involving people in decisions about their care.

People told us they felt safe living at Acorn House Care Centre. Staff had undertaken safeguarding training and knew their responsibilities. The registered manager had addressed some staffing concerns from our last inspection and ensured staff were utilising their time better. The service had effective systems and processes in place to control the spread of infection and to learn from accidents, incidents and near misses.

Staff told us, and records confirmed, they completed an induction when commencing employment. The registered manager ensured staff completed a variety of training courses. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager told us people had access to advocacy services. People told us staff were kind and caring and relatives were complimentary about staff. The service had equality and diversity policies and procedures in place. People told us staff respected their privacy and dignity; staff closed doors when supporting people with personal care.

The registered manager had ensured people’s access to activities had improved since the last inspection. The service had an experienced activities co-ordinator in place and we received positive feedback about the increase in activities. People knew how to complain, and the registered manager had dealt with any complaints in line with policies and procedures.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 19 October 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to medicines, supervision of staff, recruitment, person-centred care and governance (including audits, record keeping and failure to improve) at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Acorn House Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Acorn House Care Centre is a residential home and is located in Blackburn, Lancashire within easy reach of the town centre. The service is registered to provide nursing or personal care for up to 32 people. Nursing care was not provided at this service. On the day of our inspection there were 30 people using the service.

The service did not have a registered manager in place. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons.' Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager had been identified and commenced their employment on the second day of our inspection. They would be applying to the Commission to register in due course.

We undertook a comprehensive inspection of Acorn House Care Centre on 31 January 2017. The overall rating from this inspection was Good, with requires improvement in responsive. This was due to concerns around the lack of activities and stimulation for people who used the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question, is the service responsive, to at least good. We checked the action plan had been met during this inspection and found no improvements had been made and the overall rating had deteriorated to requires improvement.

During this inspection we found breaches of the regulations in relation to meeting peoples nutritional and hydration needs, good governance, staffing and person centred care. We have also made recommendations in relation to deprivation of liberty safeguards (DoLS) applications, consent, dignity and respect, nurse call system, recruitment, medicines and care planning.

You can see what action we have told the provider to take at the back of the full version of the report.

We received information prior to our inspection that staffing levels were low within the service. Most of the staff we spoke with told us there was not enough staff on duty. People who used the service told us they regularly had to wait long periods of time for support. We found there was a lack of sufficient numbers of suitably qualified, competent, skilled and experienced persons employed to meet the needs of people using the service.

Recruitment systems and processes were not always robust. The required amount of adequate references were not always gained when recruiting staff. We have made a recommendation in relation to this.

Medicines were not always managed safely. The interim manager had highlighted a number of areas of concern and were making progress to address these. However, we found issues in relation to ‘as required’ medicines, storage of thickeners and the safety of medicines being returned to pharmacy. We have made a recommendation the service considers current best practice guidance.

Records had been kept in relation to accidents that had taken place at the service, including falls. We found that all accidents, including falls, were recorded and then analysed at the end of each month.

In the main, we observed the service to be clean and tidy. All the staff we spoke with told us they had undertaken training on infection control and knew their responsibilities. Infection control policies and procedures were in place.

Throughout the first day of our inspection we saw people were only offered a drink at certain times of the day, despite some people having had urinary tract infections. Records showed people had been losing weight, however, weight records showed this was not being monitored closely.

Whilst we saw the interim manager had made 15 DoLS applications, we found they lacked detail and some information had been copied/repeated on all of them. We have made a recommendation that best practice guidance is consulted for future applications.

Throughout our inspection we also observed staff gaining verbal consent from people. However, records we looked at had been signed by family members to consent to care and treatment. Family members did not always have the correct authority in place. We were assured this would be addressed as a matter of urgency.

Records we looked at showed that prior to moving to Acorn House Care Centre, a pre-admission assessment was undertaken. These assessments were detailed and would ascertain if the service could meet their needs.

Records we looked at showed the service involved other health care professionals, such as, GP’s, dieticians, speech and language therapists and district nurses, as and when required.

All the people we spoke with told us staff were kind. During our inspection, in the main, we saw interactions with staff that were kind and caring. Whilst we had to speak to the interim manager about the conduct of one member of staff, we observed kind and caring interactions.

We saw care records which explored people’s sexuality in order to meet their needs. There was equality, diversity and human rights policy and procedure which described the service aim to ensure equal opportunities for everyone.

There continued to be a lack of activities and stimulation for people who used the service. We saw people were asleep in their chairs for long periods of time, without any interaction or stimulation. The activities co-ordinator was relatively new in post.

Whilst we found care plans contained a lot of information about the person, we found care plans did not always reflect people’s current healthcare needs and support. The interim manger was aware of this and was taking action to ensure these were updated.

There was a complaints policy and procedure within the service that was accessible to everyone. This was also available in easy read format. We saw complaints had been dealt with in line with policies and procedures.

Whilst we saw the interim manager had started to make some improvements within the service, we found the service was not always well led. Some of the records we looked at during our inspection were not contemporaneous. Staff felt they were not supported by management and discussed a low staff morale. Whilst audits highlighted most issues we had found on inspection, we did not see any evidence that these were being addressed within documented timescales.

Acorn House is located in Blackburn, Lancashire within easy reach of the town centre. The service is registered to provide nursing or personal care for up to 32 people. On the first day of our inspection there were 29 people living in the service with one person admitted on the second day of our inspection.

The service had a registered manager in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There was a lack of activities and stimulation for people who used the service. The activities co-ordinator was working as a care staff on both days of our inspection. Records we looked at showed that concerns had been raised by relatives of people who used the service in the past about the lack of opportunity to undertake activities.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to.

The management of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare. The service was clean and tidy and there were no malodours.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed. The service had achieved a five star, very good rating from the national food hygiene rating scheme.

All staff members had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of their responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Care plans contained people’s personal preferences so they could be treated as individuals.

People were given the information on how to complain with the details of other organisations if they wished to go outside of the service. The complaints procedure was displayed in the entrance of the service for visitors to see.

Staff and people who used the service all told us managers were approachable and supportive. The registered manager told us they received support from the providers.

Meetings and supervisions with staff gave them the opportunity to be involved in the running of the home and discuss their training needs.

The manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

The service asked people who used the service, family members and professionals for their views and responded to them to help improve the service.

People told us they were happy with the care and support they received. We observed staff treating people in a friendly and respectful way. Comments from people living in the home included, 'It's a nice place and staff are always good to me', 'They look after me and keep me well, I am very happy here'.

During our visit we found all areas of the home to be bright, safe and comfortable. We found improvements were on-going and there were systems in place to maintain standards of the environment, equipment and standards of cleanliness. People told us they were happy with their rooms and most had brought in personal items to make them more homely. One person said, "My room is lovely; it's clean and bright and I have all the things that I need".

Records confirmed a safe and effective recruitment process had been followed which should help to make sure that only suitable staff were employed. Staff had undertaken training that gave them the skills and knowledge to meet peoples' needs

People told us they had no complaints about the service but felt confident they could raise any concerns with the staff or managers. People were encouraged to discuss any concerns during day to day discussions with staff and management, during meetings and reviews and also as part of the annual survey.

We spoke with three people who used the service. They told us they were happy with their care and accommodation and said they were treated very well by the staff at the home. They commented, "The staff are good to me' and 'I'm very happy here'.